A Posse Ad Esse
by Muffy Morrigan
Summary: After an uneventful hunt, Sam and Dean stop and find themselves faced with a future they never dreamed they would have to endure. Sick Dean, not death fic. Multum in Parvo Verse
1. Chapter 1

_A/N It's been some time since we were together, I know. A long time ago, I said there would be more stories in my __**Multum in Parvo**__ universe, and here we are—as promised. For those of you who haven't read Multum, all you need to know is Dean has a serious illness called Gastroparesis and in the first story they discovered it was aggravated by esophageal spasm. Thank you all for reading and reviewing. HUGE HUGE thank you to all of you who have gotten involved in the awareness campaign for GP and related disorders. And huge huge huge huge hug to all of you who are there for this little ol' writer me._

**A Posse Ad Esse**

_**Then**_

"…_Now with this esophagus on top of it—I've known that I was probably heading for a permanent feeding tube sometime, but..." Dean blinked again, a tear shimmering on his lashes. "If that doesn't work, there are other options, IV that kind of thing."_

_"Dean..." Sam was trying to get his head around all the information._

_"It's funny, I can face down the apocalypse, the end of the damn world and say okay, let's get the party started. And this—this..." He stopped and looked up, meeting Sam's eyes. "I'm scared to death, Sam. It's out of control and it's my own body. I can't eat anymore, and I didn't even know how much that meant—being able to just eat whatever I wanted to, when I wanted to. Some days all I can do is keep water down, and that's a struggle. Other days I can eat, but it just sits there. I..." Tears were tracking over Dean's face. "And now this? My esophagus, Sammy. What happens when it just doesn't work anymore? What happens when... When..." And Dean broke, a soft sob escaping his lips._

_Sam pulled his brother into a tight hug, letting his own tears fall._

_**Now**_

There was a cold wind blowing, buffeting the car as they drove into town. It was one of those odd towns that only seemed to happen in the desert West. Miles of nothing but sand and scrub plants, then out of nowhere, trees would appear in the distance. The closer to town they got, the greener it was—fields of hay and alfalfa, then the lawns of outlying houses. Even though it was early, they had decided to call it a day. _More to the point, I did. _Sam looked over at Dean. His brother swallowed again, an odd expression on his face. He'd been watching Dean for two days as they finished up the last case, and there was definitely something wrong. Dean thought he was getting away with it, which meant it was something serious. He was in full-on Stealth Mode. Sam huffed softly, Dean still thought Stealth Mode worked—when it actually had the opposite effect. Sam paused. Maybe that was Dean's intent all along?

"This place look okay, Sammy?" Dean asked, pulling into a motel parking lot. It looked clean and freshly painted—a step up from the last one where Sam had to wrestle the cockroaches for his toothbrush in the morning.

"Yeah." Sam got out of the car and headed in to register. The clerk was friendly and the office was clean as well. After she made sure—for the fourth time—that Sam knew a free hot breakfast came with the room, she handed him the keys and a parking pass to put on the dashboard of the car. When Sam turned to walk out of the office he caught sight of Dean, his face was white and he looked completely freaked out. As soon as Sam opened the door, his brother had his expression schooled back to normal, and by the time Sam dropped back into the car, Dean slid an eyebrow up at him and smiled. "What?" Sam snapped.

"I think she thought you were pretty hot."

"Dude, she was old enough to be my grandmother."

"She totally thinks you're hot."

"Shut up, Dean."

"I won't wait up tonight so you can have some time with her," Dean continued as he pulled into the space Sam pointed to and turned off the car. "Do you need the keys?"

"Bite me, Dean." Sam said, then saw the glint in his brother's eye. "Don't even say it."

"Didn't say a thing,"

"You were."

"Nope. Not a word, not a single word." Dean grinned. "What would I say?"

Sam sighed and grabbed his bag out of the trunk. As he walked past Dean his brother growled. "Just stop, Dean!" Sam grumbled. Dean started laughing. Sam kept his face turned away from his brother, but couldn't help grinning. He was just putting the key in the lock when Dean made a funny little sound that triggered the panic button in Sam's head. He was back beside Dean in less than a second. "What? Dean!"

"Sam," Dean ground out, his hand fisting in Sam's shirt.

"Where's the nitro?" Sam asked, reaching around Dean to dig through his bag. He found the bottle, fished out the smaller glass one and shook a pill into his hand. He gave it to Dean and waited. This was the fourth time in two weeks Dean had needed the nitro, it was just one more reason the Stealth Mode was worrying Sam—Dean wasn't hiding this, so what the hell was he trying to hide? "Dean?" he asked several moments later.

"Thanks." Dean straightened and Sam steadied him as he swayed. "I'm okay."

"You sure?" Sam opened the door and waited as his brother walked into the room. He could tell Dean was still in pain from the stiff set of his shoulders.

"I'm going to take a hot shower," Dean said, dropping his bag on one of the beds, grabbing some clothes and the Ziploc bag he kept his meds in. "You want to order food?"

"Yeah." Sam tossed his bag on the other bed, wondering what he should order. Dean had been sticking to light foods for the last few weeks. After looking around the room, he found a binder that listed local restaurants and ordered from a Thai place, making them read the order back so that Dean's food had none of the items that tended to upset his system when he was having a bad flare of the gastroparesis. Sam sighed, there was something more going on, though. The nitro pointed to that—he had also noticed Dean using the other prescription for his esophageal spasm almost every day.

"That helped," Dean said, coming back into the room.

"It did?"

"Yep." Dean dropped onto the bed and grabbed the remote. "What's for dinner?"

"Thai?"

"Rice?" Dean was flipping through the channels.

"Double order, and they have that peanut sauce dish you like."

His brother looked a little green for a moment, then smiled. "Thanks, Sam, I'll wait for it if you want to clean up."

"I will, that last motel was a little…"

"Gross and disgusting even by our low standards?" Dean finished with a grin. "One of the cockroaches tried to carry off my razor."

"I just gave them my toothpaste when we left."

"I'm sure the next people who use the room will appreciate the fact the bugs are minty fresh," Dean said, laughing. Sam was watching him closely and caught the twinge of pain that flashed across his brother's face as he laughed. "I'll be right back." Sam headed into the bathroom. Dean's meds were back in their bag, but the one for spasm was nearest the top which meant he'd taken a dose of that as well as the nitro. _Not comforting. _He set his things by the sink and turned the shower on.

"Guess what's on tonight?" Dean raised his eyebrows as Sam came out of the bathroom in a billow of steam.

"Oh god, not Spinal Tap."

"Even better, the History channel is having a marathon of Apocalypse shows."

Sam smiled at Dean. "Awesome." The first time they'd watched one, it had been because the hotel they were at only hade three channels and two were questionable at best. Dean muttered something about never watching anything that involved anyone sewing anything. They'd settled on a show made in 2005 on the "Coming Apocalypse" and spend the evening talking back to the TV and laughing. Since then, they looked for the shows and the opportunity to turn them into a running commentary.

"It starts off with that one about the manuscript."

"The one that three shows later they prove was made in the Nineteenth Century?"

"Yep, one of my all-time favorites."

"Mine, too." Sam leaned back against his bed and waited for the food. He kept one eye on his brother. Dean was rubbing his chest. Without asking, Sam got up, grabbed the heating pad from the bag, plugged it in and placed it on Dean's chest.

"Thanks."

They were twenty minutes into the show when the food arrived. Sam paid for it and set Dean's down on the night stand, then dropped back down to watch the show. His brother had been keeping up a running commentary since the show started, and Sam listened with a grin on his face while he ate his pad thai.

"Sammy?"

The tone in Dean's voice switched on the alarm in Sam's head so fast he was up, on his feet, gun in hand without even remembering reaching for it. "What?" he snapped, adrenaline making his heart slam in his chest.

"It's not that," Dean said softly, his voice strained. "I can't swallow."

"Can't swallow how?" Sam asked, dropping the hammer on the gun and setting it down on the bed.

"When I try to swallow the rice it comes back."

"Vomit?"

Dean shook his head. "No, it just pops back whole. Never gets past my throat. It might have been happening off and on for a few weeks, but I've been having a lot of trouble today. Even spit feels like peanut butter."

"Dean…" Sam broke off and shook his head. "Have you called Brian?" Brian Gleason was Dean's Gastroenterologist and Sam knew his brother called him far more than he admitted.

"I did, he said keep an eye on it and call him if it gets worse."

"This counts as worse." Sam pulled his phone out and punched the speed dial. It was still early enough to catch someone in the office. When the recording at the office came on he entered the nurse's extension. He managed to catch her at her desk and explained what was going on. Since finding out about the gastroparesis, Sam had spoken to Layne many times.

"What's going on?" Dean asked.

"I'm on hold."

"Sam?" Layne said, coming back on the line. "Doctor wants Dean to go to the ER immediately. He's calling ahead to get everything set up for a barium swallow."

"Thanks, Layne." Sam closed his phone and looked at Dean.

"ER?" Dean asked, standing up.

"Yep." The fact Dean was going without a fight scared the hell out of Sam. "Got everything?"

Sam grabbed their new "official ER bag". It had two ebook readers, power cords for their phones, insurance cards, living will, medical power of attorney and a list of Dean's meds. Something twisted in Sam's chest—they had been in and out of emergency rooms for years, but the fact they now had all this just waiting showed the huge change in their life. They both worked so hard to keep everything normal, even when it wasn't, but sometimes they couldn't avoid what was happening. He could tell from the tension in Dean that his brother was trying not to panic. Sam smiled and walked to the door nudging Dean with his shoulder as they headed out.

"It's probably nothing," Dean said.

"Yeah," Sam agreed.

They both knew they were lying.

_**To Be Continued**_


	2. Ut Dictum

_A/N: Thank you all for reading and reviewing. It's good to be back sharing with you. As I carefully pick out these titles I wonder if I should translate them—or let you go hunting Sam Winchester style. I have a deep respect for the medical profession, I have close friends who are nurses and my specialists and doctors are amazing. I have had wonderful experiences in Emergency Rooms. However, they are not all perfect, and sadly—as they used to say on Dragnet—the story you are reading is true the names have been changed to protect the… well you'll see._

**A Posse Ad Esse**

**Ut Dictum**

The waiting room was overly warm. Sam could feel sweat trickling down the back of his neck, he was trying hard not to squirm, but the sensation was almost impossible to ignore. Dean was sitting quietly beside him, the blood pressure cuff they'd used when they first arrived in his hands. Every time his brother swallowed, Sam was aware of the little tensing of muscles, indicating his brother was in a lot of pain.

"How long?" Dean asked.

"An hour and a half," Sam growled. "I'll be right back." He got up and paced over to the reception desk. "Hi, I was wondering how long it was going to be?"

"Who are you?"

"I'm with Dean Iommi. We've been here three hours. His doctor said he called ahead and said you would know what was going on?" Sam kept his voice light. Starting a fight right now probably wouldn't help Dean.

"Oh, yes, I see," the woman said, looking down at some papers. "We'll get to him as soon as we can."

"He can't swallow."

"We will get to him as soon as we can."

"The guy with the flu was taken back twenty minutes ago!" Sam huffed. He shook his head. Killing the reception staff wouldn't help Dean.

"Well?" Dean looked up at him as he stalked back.

"They will get to you as soon as they can."

"Killing them won't help, you know," Dean said, grinning. "You know the drill. They don't believe me, they don't understand how if it hurts as bad as I say it does if I can say it calmly."

"Remember that bitch in California that said you should only be capable of screaming if you hurt that bad?" Sam asked, sitting down again.

"Yeah."

"You screamed."

"I did, scared the hell out of them." Dean leaned against him. "It's the same, every time in every city. Much easier to get help when the blood is gushing."

"Yeah."

"It's okay."

"Dean…" Sam took a deep breath. His brother was right. They had sat in many emergency rooms while doctors told them there was nothing wrong, it was all in Dean's head and other equally degrading things. It was one of the reasons it was getting harder and harder to get Dean to go in at all and why the fact he came willingly this time was making Sam panic. It had to be beyond bad for Dean to walk into the place—especially after the last time when both nurse and doctor had told Dean it was all in his head and he was just exhibiting drug seeking behavior.

"Dean? Dean Iommi?" a man in scrubs called.

Dean stood and Sam followed. They were led to a small room, and Dean sat in the only chair. The man—his ID said his name was Pat—took Dean's blood pressure, pulse and temperature again, then started poking at his face.

"Any pain here? Or here?"

"No, I can't swallow."

"Nausea? Vomiting?"

"Yes, I have gastroparesis."

"Ah. Chills? Coughing?"

"Wait a minute," Sam said as what was going on dawned on him. "Are you triaging him for the flu?"

"Yes?" Pat said.

"He can't swallow. His doctor called ahead. He is supposed to be scheduled for a barium swallow, they told us to come here immediately because he couldn't swallow his own saliva."

"Oh, huh. Well, go out to the waiting room and I will see what's going on."

"Sammy." Dean put a hand on Sam's arm. "Don't." He stood and walked back into the waiting room and sat back down in the chair he'd just vacated.

Sam started pacing. He was beginning to get anxious on top of the panic and it was going to explode in something bad if he couldn't rein it in. He started counting his steps, concentrating on the steps, the color of the tiles, how many tiles for each stride, how many strides across the room. It would only work so long, so he hoped they would get it figured out quickly. Every time he looked at Dean he felt that flutter of panic. His brother was getting worse, not better. The tight lines around his mouth meant the pain was starting to creep up the scale beyond where Dean could ignore it.

"Dean?" a woman in purple scrubs called from the door.

"Here," Dean said, standing and walking towards her.

"You need a pass from security," she said to Sam, pointing at a window where a guard sat watching TV. "Room fifteen, Joe."

"Right," he said, bored, and handed Sam a bright orange sticker that had Dean's name on it and "Room 15".

"Thanks." Sam peeled the back off the sticker and stuck it on his shirt as he trailed behind Dean and the nurse. As they walked in the back, he noticed most of the rooms were empty.

"Take off everything above the waist and put this on, it ties in back."

"It's not my first hospital gown," Dean growled. He handed Sam his shirt, then leaned back on the bed as the nurse asked him questions and took his vitals again. "I can't swallow. Dr. Brian Gleason said he was calling to arrange…"

"Yes, I see that. We are doing our best, the radiologist went home half an hour ago."

"We were here three hours ago. He called before that," Sam said, trying to control the rage that was starting to boil along his spine.

"Yes." The nurse gave them a smile and walked out, closing the curtain behind her.

"What the hell?" Sam looked out into the main area of the ER, the nurse was talking to a small dark-haired woman in a white coat.

"It's the same thing as usual."

"I am getting tired of the same thing as usual, Dean." Sam leaned against the bed so he could be in contact with his brother.

"I know, Sammy." He sighed, shifting in the bed.

"I'm Dr. Walters," the dark-haired woman said, coming into the cubicle. "What's going on tonight?"

Sam took a breath in and let it out slowly. "My brother can't swallow, his doctor phoned and arranged a barium swallow and told us to come to the ER," he looked at the clock on the wall, "four hours ago."

"Our radiologist has gone home," she said.

"We heard," Sam growled, Dean patted his hand.

"What is it like when you try to swallow?" she asked, glaring at Sam, then turning her attention to Dean.

"Really thick peanut butter and it feels like it gets stuck half way down. I have esophageal spasm and…"

"Okay, we will get an IV going and see what we can do." She walked out before they could say anything.

"This one is fast becoming a special experience," Dean said, smirking at Sam.

"It is." Sam stepped aside as a nurse came in and started an IV, hung a bag of liquid on the hook over the bed and left. "They are talkative too."

"Can you lift the bed? It's easier to swallow."

The nurse was back with a handful of syringes. She smiled and twisted one on the port on the IV. Sam stopped her. "What is it?"

"Just a flush, then something to help… Dean… with his swallowing." She glanced at Dean's wrist band to confirm his name.

"I hate the way the damn flush tastes," Dean grumbled when she left. "I wonder what they gave me, I don't feel any different."

"Maybe it takes time?"

"Yeah, IV meds always take time."

Sam started pacing again. This was beginning to feel like the debacle several months before that resulted in a formal grievance filed against the hospital where Dean was treated. The fact that so many people were willing to just dismiss his brother's pain as nothing… "Hey, no one asked about your pain."

"What?"

"They didn't do that one to ten thingie."

"They didn't." Dean frowned. "That's a first."

"Hi! I'm Terry." A man in scrubs came in with a cup in his hand. "The doctor wanted to see if the drugs worked."

Dean gave Sam a funny look, but took a sip from the straw in the cup. He pulled away, looking green. "Can we try just ice water? I am not sure apple juice is a good idea right now."

"Oh sure, be right back." And he was, with another cup and straw. He held it while Dean took a sip. Sam watched his brother's muscles tense with the first swallow. Dean took a second sip—and started coughing, water running out of his mouth.

"Don't think the meds worked," Sam snapped, as Dean leaned back in the bed, white as the sheets. "No one's asked about his pain either."

"What?" Terry asked, looking surprised.

"No one has asked if he's in pain, or done anything about the nausea."

"Are you in pain?"

"Yep, about a nine."

"Nauseous?"

"I have GP and just drank apple juice. Yes, I am nauseated."

"Okay, I'll see about that. Here." He handed Dean one of the bright blue vomit bags and disappeared.

"What do you think they gave you?" Sam asked. "They seem to think you should be better."

"I think they gave me jack because I am obviously nuts."

"But the doctor told us to come."

"I know. You know. They suck."

"Hey." Terry stepped back into the room. "I have some morphine and Zofran."

"Phenergan works better," Dean said, sighing as the morphine hit his system.

"We have to give the Zofran first."

"Because it is more expensive and not as caustic."

"Uh, yeah," Terry said, looking a little confused.

"We've been through this before." Sam was watching the other man.

** X**

Dean was watching Sam pace. It seemed to be the only thing keeping his brother in check. The doctor had shown up twice in the last two hours to tell them she was working on getting them the scheduled barium swallow the next day. Sam growled a little louder every time she came back. Terry checked on Dean regularly, even though he was not the nurse assigned to his case. It was getting harder and harder to concentrate, though, because even with the morphine and anti-nausea drugs in his system, he still couldn't swallow and the slowly tightening muscles felt like being choked to death.

Unfortunately, that brought back a memory of almost being choked to death. That anxiety combined with the spasm that was already wrapping an iron band around his chest kicked off the worst spasm to date. He was pretty sure it was going to kill him this time. They finally hooked him up to some oxygen, but it was way past his ability to keep it under control. Usually a little morphine, some deep breathing, Phenergan and he could leave in one piece. This time it was completely beyond his control and he could feel tears trickling, unbidden, over his cheeks. Dean tried to stop them because he knew it freaked Sam out, but he couldn't this time. Sam glanced over at him, stopped, squinched and walked out of the room. Dean could hear his voice and a moment later Terry was back with Sam and a syringe. Dean heard "more morphine and Ativan" and then the weird pressure at the base of his skull that he always got with morphine.

It knocked it all back enough for him to take a breath. He closed his eyes and let the drugs work and started to get things under control.

"What?" Sam's voice had the low dangerous pitch that kicked off the alarms in Dean's head. He opened his eyes, his brother and the doctor were standing just outside the curtain.

"Sir…"

"Oh no, oh hell no," Sam growled. "I want him transferred right now."

"Sir…"

"Transferred now."

"Mr. Iommi…"

"Did you or did you not give my brother a shot of sugar?"

"Sir…"

"Sammy?" Dean called, the tone in Sam's voice was scaring him. When his brother stepped into the room he was even more worried.

"We're getting you transferred to the hospital in the next town, Dean."

"No…"

"Yes, we are, doctor. We are transferring him, you are calling ahead and arranging it and I will be calling his doctor and making sure they know why we are there and who they need to talk to about what's been going on."

"Sammy?"

"A fucking placebo, Dean. They gave you a fucking placebo. We waited until the radiologist was gone—even though they were expecting you and then they gave you a placebo because this woman thought you were faking. We are going."

"Sir, I…"

"I want his chart too."

"You can have it during normal business hours."

"No, I saw the supervisor out there, I want it right now. The whole damn thing photocopied. In my hands and in my sight. I don't want anything going missing."

"Sammy?"

"I already called Brian's service and left a message." Sam loomed over the doctor.

"Here's the chart," Terry handed Sam a sheaf of papers.

"I won't authorize a transfer by ambulance," the doctor said.

"That's fine," Sam said, his voice so completely calm Dean was surprised that the order to evacuate hadn't been given. Hurricane Sammy was about to blow. "I'll transfer him." He handed Dean his shirt. "And we'll be talking again soon too, I think, doctor."

"Sam?"

"Can you make it for about fifteen minutes, Dean? Terry told me how to get to the hospital the fastest way."

"Is that why he just gave me the morphine and Ativan?"

"Yeah."

"Okay." Dean let his brother help him off the bed and they headed towards the doors.

The doctor was walking towards them. "Just don't," Sam said, opening the door. He smiled sweetly at the girl at reception. "Can I get the number for feedback? I want to make a comment about our awesome care."

"Sure, here it is."

"Thanks." Sam tucked the card in his pocket.

"Brian told us to come."

"The order was here."

"They ignored it," Dean said.

"They did worse than that Dean. I'll tell you when we get you comfortable." He helped Dean out to the car and carefully closed the door.

"Okay." Dean closed his eyes and focused on not panicking as he tried to swallow through the pain and the terrifying band around his throat. "Not far, right?"

"Nope, just hang on."

"I'll do my best." Dean felt a tear trickle over his cheek.

_**To Be Continued. **_


	3. A Posse Ad Esse

_A/N: I know it's been a little while since I posted to this story. It's proving to be harder to write than I thought. I am posting today in memory of the lives lost in the last three months to Gastroparesis. Some were my friends, some friends of friends and some names on support pages—and I am very sure there were more that died. This is in their honor. We need a cure, we need hope, and we need awareness. Thank you for reading._

**Chapter Three**

**A Posse Ad Esse**

The car was quiet except for Dean's strained breathing. Sam was completely focused on getting to the hospital as fast as possible, the fact he could see the tears tumbling over his brother's cheeks was terrifying. It meant the pain was completely out of control and the look that crossed Dean's face every time he tried to swallow added a whole new level of panic for Sam. He had the urge to get Dean to the hospital and then go back and have a word with Dr. Walker, but right now he knew that would be a very bad idea. He hadn't been this angry towards _anything _that had injured his brother in a long time—and that thing had been hacked to pieces.

"Elm Etreet, we're less than a mile away, Dean," Sam said, turning the corner.

"Good," Dean whispered. "Sorry."

"You have nothing to be sorry for. That last hospital needs to say sorry, not you." He pulled up into the loading zone at the emergency room and got out. He handed the keys over to a valet and took the ticket, all in one motion as he bent to open the door for Dean. Sam eased his brother up and out, maneuvering him into a wheelchair and through the doors. He headed straight for triage.

"Can I help you?" the receptionist said.

"Hi, this is Dean Iommi…" Sam didn't get a chance to finish.

"We were expecting you," she said. "This is Chris, he's our triage nurse."

A medium-sized man came around the desk and pushed the wheelchair to the blood pressure machine by the doors into the back of the ER. "How are you feeling?"

"Awesome," Dean choked out, his voice harsh. "Can't swallow, chest hurts."

"Nauseated?"

"Yeah."

"How's your pain? From one to ten?" Chris said, looking at the blood pressure machine.

"Not even close."

"Your blood pressure is a little high."

Sam looked over at the machine. "He usually runs low, so that's really high."

"I understand. Let's get you back and settled and the doctor will be in to see you." He pushed a button on the wall and the doors opened. They headed back into the ER and Sam already felt better, the place had a sense of quiet efficiency, most of the rooms were single, only one or two had curtains dividing the bed. They were in room nine. Chris helped Dean onto the bed and handed him a gown. "I need to get an EKG."

"I have esophageal spasm."

"I know, but you reported chest pain and we have to jump through all the hoops."

"Yeah," Dean said, sighing. "I know." He held still as Chris put the stickers for the EKG on, then leaned back in the bed.

"This looks good," Chris said a moment later. "But you knew that."

"Yeah." Dean took the gown Chris handed him and leaned back.

"I'll be right back with some fluids."

"Thanks." He waited until Chris left, then smiled at his brother. "Handy for them that you dragged me out of the other place before they could pull the IV."

Sam tried to keep the rage out of his voice. "Yeah." He was about to say more when his phone rang, he pulled it out and looked at the caller ID. "It's Brian," he said to Dean before answering. "Hey, Brian."

"Sam, what the hell is going on? I called to get the results of Dean's test and I was told it never happened. My service said you called and were having Dean transferred to Sacred Heart."

"I transferred him, they refused an ambulance. One of the nurses _did _care and helped as much as he could."

"They refused?"

"Yeah, they did—and more. We got to the other place just after I talked to you. We were in the waiting area for almost four hours and back in the ER for another five. They gave Dean a placebo!" He took a breath to get his anger under control. "He finally got pain meds about six hours after we got there and by then…"

"It was too far gone to control. You have the chart?"

"Yeah."

"Okay, read me the list of meds."

Sam did as he was told, the anger beginning to bubble again when he got to a note on the chart. "What the fuck?"

"Sam?" Dean and Brian said together.

"It says 'patient is playing games on his phone with his brother in no apparent distress'. We were playing them because Dean needed distraction!" He read further, and it didn't help. "What the…"

"Killing them won't help," Dean said softly, the pain so evident in his voice Sam could barely stand it.

"Is he still having the issue with swallowing?" Brian asked, pulling Sam's attention away from the notes.

"Yes. I think it's getting worse," Sam replied.

"What?" Dean asked.

"Swallowing?"

"Sucks," his brother replied.

"I heard that," Brian said. "Let me make a call or two."

"Okay." Sam leaned against the bed.

"And Sam?" Brian said, humor in his voice.

"Yeah?"

"Don't kill anyone just yet."

"Okay," Sam agreed, feeling like a weight had been lifted from his chest. He broke the connection and a few moments later the phone at the nurses' station was ringing. One of the nurses answered, looked over towards him and handed the phone to a tall blond man.

"Here you go," Chris said, coming back in the room. "I have something to help with the pain. We're going to give you some nitro too, okay?" the nurse continued. Dean nodded. "I have morphine and Phenergan here." He flushed the port and gave Dean the drugs. "I'll be back in a little bit to check on you and Dr. Borman will be over in just a moment."

"Thanks." Sam watched as Dean relaxed a little, then turned his eyes back towards the man on the phone. Sam knew the nitro tended to give Dean a headache, but it helped the spasm more than most things. The combination of pain killer and nitro usually stopped the spasms, or brought them to what his brother considered "manageable" pain.

"Feeling better?" Dean tapped Sam's arm.

"What?" Sam frowned, looking at his brother. "They seem a little better here. You?"

"Making it," Dean said, he still had far too much tension in his body.

"That's not really good enough." Sam tried to get his anger under control. It wasn't helping Dean, and he had no idea how things would go. He took a deep breath.

"No," Dean agreed, "but it's more help than we had in nine hours at the other place."

"Yeah, and so far no placebos."

"What else happened?" Dean asked. "Sammy?"

"That bitch told me the radiologist would be back in two days. She was going to release you. I told her you couldn't swallow, and she smiled and said she was sure the one bag of IV fluids would keep you just fine until the test."

"She thought there was nothing wrong. It's happened before, Sam, you know that. One out of three trips to the ER, they think I am crazy."

"She knew you couldn't swallow and would go two days without any liquids. Dean, that's torture."

"Giving me a placebo was probably torture too."

"Yeah. It was." Sam smiled, or tried his best. "When you're better, I am going to splash some holy water on her. If she even looks annoyed, I'm killing her."

"Sammy…"

"No, Dean, I'm tired of you suffering like this, when they could help. They can't listen to a damn word we say, they act like you are invisible or faking or what did that one asshole say, 'functional illness', and every single time they add something like that to a chart, it's another black mark against you. I'm getting sick of it. You are in pain. You, YOU are letting me take you to an ER and they treat you like shit."

"I know," Dean said, shifting on the bed. "I'm tired of it too. It's bad enough having the illness, not being able to eat most of the food I love, but not even being able to get help when it gets bad is not fun."

Sam tried not to stare, he knew the drugs were kicking in and that combined with the pain was making Dean more open than usual—and that made Sam's rage go up a notch. "One day, I am going to snap."

"Just don't hit whoever has the meds before I get them, okay?"

"Deal."

The blond man came into the room. "I'm Dr. Borman. I just got off the phone with your doctor. He was a little… adamant." He smiled. "How are you feeling? Pain level?"

"Still at nine."

Sam saw the doctor's eye flick up to the monitor then back down at Dean. "We'll get you a little more comfortable, but I'd like to get the barium swallow done first if at all possible. You've had one dose of nitro and morphine, can you make it for half an hour? Radiology will be here in a few minutes."

"Yeah, I can make it."

Sam didn't believe it. He could hear the pain in Dean's voice. "Dean?"

"The better picture they get, the less likely what we were talking about will happen again."

"Fine, but I'm coming with you."

"Don't bother protesting," Dean said to the doctor. "You won't change his mind."

"No," Sam said firmly. He had no intention of letting Dean out of his sight. If that meant breaking hospital policy, he didn't care at this point. After what had happened at the other hospital, he was going to check every vial, ask questions till they hated him and make sure he knew what was going on. "I'm going."

** X**

The floor was busy and had that scent Dean always associated with hospitals—stale coffee and some kind of meat gravy. Every hospital he'd been in had the same smell emanating from somewhere beyond his room. Once upon a time, the scents would almost make him hungry, now they just made him sick. He wished they had a filter that would keep it all out of his room, but even closing the door didn't change it much. At least he was finally settled in a room, not the ER. Whatever Brian had said to Borman had made it much smoother than their usual trips—except when they lucked into a town on Brian's secret network of gastroparesis specialists. When he'd finally told Sam about it all, Brian had still lived and worked in the same town as Lisa. Dean resisted returning, just in case. A few months before, Brian had moved his practice so he could be closer to his family and Dean was now seeing him more regularly. It didn't change what was going on, but seeing Brian made is seem more manageable.

Dean sighed. They were finally giving him the right meds to stabilize the pain and nausea. He still couldn't swallow and the barium swallow had been miserable. The staff was kind and treated him well, but Sam growled out a question every time they asked him to swallow something. Dean understood. Sam felt as helpless as Dean did when his brother was injured or ill. The big problem was this particular issue was like a never healing wound for them both, and Sam was getting raw—reacting with anger much faster than he once had—not that Dean blamed him, getting told repeatedly it was all in his head was getting old. They had records they carried with them, notes from Brian and four other doctors stating clearly what was going on, but Dean was still mistreated more often than not.

He'd sent Sam off in search of food. His brother hadn't left his side in almost twenty-four hours, and Sam was beginning to show the wear of the long hours in two emergency rooms. Once he'd promised not to get in the car and go back in search of the doctor from the first ER—Sam had told him the name but he couldn't remember—Dean had let him go. It had been about twenty minutes, so he was beginning to worry what his brother was up to but trusted him to keep his word.

"Hey, man," Sam said quietly.

"Sam?" Dean blinked up at his brother. "Was I sleeping?"

"Yeah, for an hour." Sam smiled. "How are you feeling?"

"Better, still can't swallow right."

"But pain is under control?" Sam asked, his brows furled in full squinch.

"Mostly. Have you heard from the doctor yet?"

"He's on his way in, it's why I woke you," Sam said.

There was a soft tap on the door and the doctor walked in. He smiled at Dean and frowned at Sam. "I have the results of the swallow."

"And?" Sam took Dean's hand.

"There is definite dismotility there."

Sam opened his mouth, Dean squeezed his hand. "What does it mean?"

"It looks like the spasm is getting worse. I've spoken with Dr. Gleason, and he believes we should check this out a little more. We're scheduling you for an endoscopy in the morning."

"An endoscopy?" Sam asked, the concern radiating off him. "He just had one two months ago."

"I know, Dr. Gleason told me, but after conferring with him we think there's only one real solution for what's going on right now."

"What?" Dean heard the fear in his own voice. He and Brian had talked about the day when he would need a feeding tube or worse. The thing he'd been dreading the most though was the day when…

The doctor smiled the professional smile. "We're going to try stretching."

"His esophagus?"

"Yes. Until then we're going to keep you comfortable. Don't worry, it's a simple procedure." He nodded, wrote the time for the procedure on the board and left.

Dean couldn't move, the tears were already pooling in his eyes. Pain he could take, the drugs made him vulnerable. "Sammy?" he said quietly.

His brother looked at him, his eyes were full of tears too. Sam sat on the bed and pulled him into a tight hug. "I know, Dean."

"Not this, Sam. I… I'm not sure I am ready for this." Dean leaned in, grinding his teeth together as his chest began to ache, the spasm reacting to the emotion. This was the thing he'd been dreading more than anything—and now it was here, the time written on the whiteboard at the end of the bed. He closed his eyes and let go.

_No, not this. Please not this. _

_**To Be Continued**_


	4. A Priori

_A/N Thank you all for reading and reviewing and sticking with me through this story. I wish I could say what happens is entirely fiction, sadly it is mostly fact._

**A Posse Ad Esse**

**A Priori**

The hospital was quiet. It was the time of night when most of the patients were asleep and even the continual round of checks had slowed. The nurses were gathered at their station, the one time Sam had stepped into the hall, he noticed they were all watching something on a phone. The CNA had been by less than an hour before, but she had disappeared somewhere. The one good thing about the late hour was the smell of food had all but vanished, and Dean was more comfortable. Sam knew when the spasms were bad, and the nausea was worse than usual. Dean's eyes were closed and he seemed to be asleep, but Sam didn't know if he was resting or his body had just given out.

Sam huffed softly, the blacking out was a relatively new thing. Dean refused to mention it to Brian, and Sam was trying to figure out a way to explain it without his brother ending up in another endless round of tests. Dean had a theory and carefully explained it to Sam—it was his body's response to too much pain and the related stress. His brain needed time to "reset" itself and so it just shut down. The black-outs came on without warning, and Dean would be out for anywhere from fifteen minutes to three or more hours. Sam had learned to spot the signs, and Dean knew his body well enough to pull off the road if he was driving.

"Sammy?" Dean said softly, his voice full of pain. "Something's wrong."

Sam turned. Dean was white as a sheet. Without really thinking about it, he glanced at the monitor and watched as his brother's heart rate started to climb. "Dean?" He walked quickly to the bed and grabbed the hand reaching for him. "What is it?"

"Spas…" He stopped and closed his eyes. A moment later a tiny whimper escaped his lips and tears were running over his cheeks. The hand holding Sam's closed down with a crushing force. His brother's heart rate was hovering at 130. About thirty seconds after it started, Dean slowly relaxed, his heart rate dropping back down. It was still high at 90, but much better than 130. "Sorry," Dean said.

"You should be," Sam said, trying to keep his voice light. He went to the sink and wet one of the washcloths and carried it back to Dean, gently wiping the tears and sweat off his face. He was debating calling the nurse when Dean made a funny sound and Sam immediately looked at the monitor. The heart rate was rocketing up again. He grabbed Dean's hand and held on as the spasm wracked his brother's body, ending with Dean gasping for breath and gagging as he tried to swallow. Sam was reaching for the nurse call button as the spasm eased.

"Sorry," Dean whispered, collapsing back onto the bed.

"You should be," Sam repeated. It was their hospital conversation—familiar, routine, and the banter made it almost okay.

"What's going on?" the nurse, Tina, asked as she came into the room.

"My spas.. jus…" Dean stumbled over the words.

"His spasms just got a lot worse," Sam said, Dean nodded.

"He's not quite do for meds yet." She glanced at the clock. "Ten minutes."

"I…" Dean stopped. Sam immediately checked the heart monitor, it was at 115 and going up fast. Dean whimpered and held on as he shook in pain, then gasped for air as he started gagging.

"I'll see what I can do," Tina said, and hurried out.

"Thanks," Sam said, wondering what they could do. As many times as they'd been to the hospital since Dean admitted to the gastroparesis, he'd never seen anything like this—and it was scaring him to death.

**XXXXXXX**

The television was on—the Food Network was one of the few stations the hospital got that didn't resort to infomercials at midnight. It seemed bizarre, but it was one of Dean's default channels since the gastroparesis diagnosis. Even though the shows revolved around food, they weren't anything he had ever considered eating and he and Sam had spent many hours deciding the baskets for Chopped. What made the channel bearable was the fact that it had fewer ads for restaurants or food he _did _want to eat than the others. In fact, he watched far less TV than he once had, just to avoid the commercials. Sam had subscribed to an online service and as long as they had wifi, they tended to watch the computer.

Right now, none of that mattered.

The spasms in his chest had gone from uncomfortable, too painful to whatever this was—agony didn't begin to describe it because along with the pain came the sheer terror of not being able to breath or swallow as his throat closed down at the end of each spasm. Dean knew it was freaking his brother out to the point of "completely calm Sammy" which generally spelled doom. Sam hadn't stepped further away than the sink for the last hour as the spasms increased.

"Dean," Sam said, gently taking his hand. His eyes were fixed on the monitor—they'd figured out that his heart started to reflect the pain several seconds before the spasms really got going. It gave Sam time to get there, and Dean time to try and stay calm.

The calm only lasted until the weird flutter started under his breastbone. It felt like something tapping rapidly against the sternum. The flutter escalated to pain, then it felt like his esophagus was being twisted by unseen hands, the pain moved left, along his ribcage and up his chest, his neck, into his left ear and down his jaw. It increased, staying on the left side for a moment before blasting down his neck and stabbing under his right shoulder blade. He could feel Sam's hand in his and this time he felt a pop in the fingers he was holding. The pain lessened, and that signaled the worst part of the whole thing—his throat closed, and he couldn't get in air or swallow, even though his body was trying to do both. He could hear the weird noises he was making, and was aware of Sam's hand on his back, holding him upright as he gasped and gagged. After an eternity—and what Sam said was actually ten seconds—it all let go at once and he collapsed against Sam's hand and his brother eased him back down to the bed, gently wiping his face with the cool cloth.

"Sorry."

"You should be," Sam replied. They were both taking comfort in that familiar routine, although this was as far from routine as it got. "They're getting worse."

"Yeah," Dean answered, knowing that lying wouldn't help the situation—and Stealth Mode was not even possible when he was screaming in agony every few minutes. The nurses were coming and going, Dean knew they were giving him pain meds, but the meds didn't seem to be helping as much as they should. Or maybe he was too far gone to feel the effects completely. Reality was slipping a little.

"Meds are due in another twenty minutes," Sam said before he could ask.

"How…" Dean stopped the rest of the sentence seemed stuck.

"You start losing the ability to communicate. It's been getting worse too." Sam was at full squinch, his face pale with concern.

"Did… Hurt…" He remembered feeling the pop in Sam's hand during the last spasm—or had that been before?

"Hurt?" His brother frowned. "Oh! My hand. No, it just popped, it was my right hand. You know that knuckle has cracked since the ghost in Wisdom tossed me into the wall."

"Right," Dean said, swallowing. It took two tries to get it down.

"The basket was grape juice, flank steak, marshmallows and baby turnips with greens." Sam sat in the chair beside the bed, leaning his shoulder against Dean.

"Too… Ease…"

"I know," Sam said, as if Dean had completed the sentence. "You could make a gourmet meal with that."

"Hey! I… Good."

"You are. You can make food out of things that these guys would run from." Sam laughed. "Remember that camping trip when I was fifteen? You made the magic hash with dried potatoes, beef jerky and fake bacon bits?"

"Yeah." Dean also remembered the creatures stalking them, but that didn't matter. There had been times during that trip that had been fun, just the two of them hanging out together. Even before their father had left to head up a different part of the valley, it had been special. They managed to catch a few fish and had fried trout, sitting around the fire. It had been a good night, the three of them. Dean had no idea why he remembered that part so fondly, overall the trip had been a disaster.

"That was fun," Sam said softly.

"Yeah."

"And you taught me that the only good marshmallow is one that is completely burned." He smiled. "Then you peel off the burned part, eat it and put the marshmallow back in the fire."

"Only…" Dean answered, nodding. "We… Marsh…" That was getting annoying, it was getting harder to form the thoughts, let alone get them out. The steady pain was getting worse as well.

"We will. Once you're out of here, we'll go day camping."

"Right."

"No overnight camping."

"Never."

"Unless it's in a cabin, with a heater, a solid door, food, flushing toliet and a fireplace," Sam said, listing off Dean's requirements for overnight stays in the forest.

"Yeah." Even though it hurt, he smiled, thinking about it. They hadn't caught a break in a long time. Maybe they needed to make one. The world could wait.

"Dean." Sam stood and took his hand.

The flutter started, the pain started climbing. Dean was lost to everything but the agony pulsing through his body. He could hear someone screaming, and Sam's hand on his back. The points of contact with his brother was the only thing keeping him from shattering apart. The eternity without air, trying to swallow went on even longer. When it finally let him go he fell sideways, his head resting against Sam's chest.

"What's going on?" a female voice demanded.

"They're getting worse," Sam answered, his voice cold. "He can't breathe right."

"We can get him some oxygen. Does he have panic attacks?"

Dean felt every muscle in Sam's chest tighten. "This is not a panic attack," Sam growled. "This is not anxiety."

"He has had a lot of pain meds. How often does he use them at home?"

"What?" the soft whisper might as well have been a shout. Sam was vibrating with anger. Dean's eyes started to sting. The "drug-seeking behavior" diagnosis haunted them through every hospital visit anymore. Even when he was in an ER for something other than the GP, the questions still came. It was too much. He knew he shouldn't cry, there was no need, but it was all too much and tears were leaking down his face.

"How often does he use narcotics at home?"

"Are you…" Sam broke off and took a long slow breath. Dean shifted so he was lying in bed, but didn't let go of his brother's hand. Hurricane Sammy was about to blow again. "Are you accusing him…"

"The doctor has expressed concern."

"Not his doctor. We are here on orders from his doctor. You can look it up in the records. We came here precisely because of this bullshit."

"The in-house…"

"I. Don't Care. His doctor knows what is going on, your gastroenterology department knows what's going on. And this…"

"Never like this," Dean managed to gasp out, opening his eyes.

"It's never been this bad. My brother does not scream, even when his leg is half off."

Dean nodded. Sad that Sam knew that, but… Wait did Sam say he'd been screaming? That was his voice he'd heard? _Oh, shit, Sammy, I'm sorry._

"I'll see what I can do." She reached behind him and slid the oxygen on, then turned to leave. "I'll call Dr. Seir."

"No, you will call Dr. Brian Gleason, or your GI department."

"I have to follow procedure."

"Fine," Sam said, his voice without tone. She smiled and left. Dean bet she believed she'd won the fight. "I'll take care of this." Sam met his eyes, the worry and fear clear in them. "Oh no!" He grabbed Dean's hand.

The pain came so fast that time, Dean didn't even have the warning flutter. It went on forever, pulsing through his body, then the horrible gasping for breath, the gagging. When it finally released him, Dean realized Sam was on the bed, and it was his shoulder that had supported him through the last part of the eternity. He stayed where he was, trying to breathe through the mounting pain in his chest. The flutter was starting again, and there was no way he was ready for it.

Dean focused on the sensation, tying to will it away. He could hear Sam talking to someone, his voice angry, but the words had ceased to make sense. When the massive spasm started again, Sam was there, holding on, helping to anchor him. It was all he had left. The pain was out of control. He could barely form a coherent thought and he heard his voice screaming.

It finally let him go. He was trembling as Sam ease him gently back on the pillows and a moment later the cool cloth was on his forehead. Dean opened his eyes and looked at his brother. Sam was even more freaked than he'd been before. "What… Happened…?"

"It's not true, Dean."

"What?" Dean frowned, trying to figure out what Sam was talking about.

"You're in the hospital." There were tears on Sam's face.

"Huh?"

"It's not Hell, Dean. You're not in Hell." His brother took his hand, holding tight. "You were screaming you were in Hell and to make it stop. You're here, not in Hell."

As the flutter started in his chest again, he looked at his brother's tear streaked face. "Are… Sure?" The pain was spiraling up again."

"I'm sure."

"I'm…" He clamped down on Sam's hand as the twisting pain began. "I'm… not…." The last word dissolved into a scream.

_**To Be Continued**_


End file.
